Association Between SGLT2 Inhibitor Use and New-Onset Atrial Fibrillation Following Transcatheter Aortic Valve Implantation: A Doubly Robust Inverse Probability Weighted Analysis

Background: New-onset atrial fibrillation (NOAF) is a common complication after transcatheter aortic valve implantation (TAVI) and is associated with unfavorable clinical outcomes. Sodium–glucose cotransporter-2 (SGLT2) inhibitors may have antiarrhythmic effects, but their association with NOAF after TAVI remains uncertain. This study evaluated the relationship between SGLT2 inhibitor use and NOAF following TAVI. Methods: This retrospective observational study included 573 consecutive patients who underwent transfemoral TAVI between January 2020 and December 2025. Patients with prior atrial fibrillation or atrial flutter were excluded. NOAF was defined as any atrial fibrillation episode lasting ≥30 s during index hospitalization. A doubly robust inverse probability weighted logistic regression model was applied to reduce baseline imbalances and assess the association between SGLT2 inhibitor use and NOAF. Results: Overall, 169 patients received SGLT2 inhibitors, while 404 patients constituted the control group. NOAF occurred less frequently in the SGLT2 inhibitor group than in controls (11% vs. 19%, p = 0.041). In adjusted analysis, SGLT2 inhibitor use was independently associated with lower odds of NOAF (adjusted OR: 0.171, 95% CI: 0.076–0.381, p < 0.001). Older age and diabetes mellitus were associated with increased NOAF risk, whereas higher baseline left ventricular ejection fraction was associated with lower risk. Subgroup analysis indicated a possible interaction by diabetes status (P-interaction = 0.040), although this exploratory finding should be interpreted cautiously. Conclusions: SGLT2 inhibitor use was independently associated with lower odds of NOAF after TAVI. These findings should be interpreted as observational and hypothesis-generating and require confirmation in prospective randomized studies.